CASE 1

Mrs. Gregg is a 55-year-old widow who has had an active career as a lawyer. She is an avid

reader. She is an independent woman who has had to adapt to many changes in her life. She

enjoys crafts and sings in the choir at her church. She has an adult son and daughter, and two

grandchildren who visit her frequently. She lives in her own home, a small bungalow in the

city.

You are assigned to give care and support to Mrs. Gregg, who had a stroke two weeks ago.

She is paralyzed on the left side and has difficulty speaking. She is able to hear well and can

understand when you speak to her. The long-term goals for her care include:

• regaining mobility
• regaining speech
• being as independent as possible
• preventing complications such as contractures and pressure sores

You are required to assist her to participate fully in all activities of daily living, and assist to

meet her physical, safety, and psychosocial needs.

QUESTION 1

1. What information would you want to find out about Mrs. Gregg and her home before
beginning her care?

ANSWER:

About Mrs. Gregg:

Medical History:

• Stroke Details:
o Type of stroke (ischemic, hemorrhagic)
o Location of stroke in the brain
o Current medications
• Any other medical conditions (diabetes, hypertension, heart disease)
 • Allergies: Medications, food, latex, etc.
• Immunization status: (e.g., flu, pneumonia)

Functional Assessment:

• Mobility:
o Ability to transfer (bed to chair, chair to toilet)
o Ability to walk with or without assistance (gait, balance)
o Use of assistive devices (walker, wheelchair)
• Activities of Daily Living (ADLs):
• Bathing, dressing, grooming, toileting, eating

Communication:

• Current communication methods (gestures, writing, communication board)

• Swallowing difficulties (dysphagia)

Cognitive function:

• Memory, attention, problem-solving

Social and Emotional Needs:

• Support system: Family, friends, community resources

• Coping mechanisms: How she has handled previous challenges
• Emotional state: Anxiety, depression, frustration
• Social interests: Hobbies, activities, social groups

Dietary needs:

• Dietary restrictions (e.g., low-sodium, diabetic)

• Preferred foods
• Appetite

About Mrs. Gregg's Home:

• Accessibility:
o Entrance: Ramp access, wide doorways
o Bathrooms: Grab bars, shower chair, raised toilet seat
o Bedrooms: Accessibility of bed, bedside table
o Kitchen: Accessibility of counters, appliances
o Stairs: Presence of stairs, availability of stairlift
• Safety:
o Smoke detectors, carbon monoxide detectors
o Adequate lighting
 o Slip and fall hazards (rugs, loose wires)
o Security measures

QUESTION 2

2. List the types of information that you would expect to obtain from the care plan:

ANSWER

• Client Information & Assessment

o Personal Details
o Medical History
o Functional Assessment
o Mobility
o Activities of Daily Living (ADLs)
o Communication
o Cognitive Function
o Psychosocial Assessment
• Care Goals & Objectives
o Short-term Goals
o Long-term Goals
• Care Plan Interventions
• Communication & Collaboration
o Communication with the client and family
o Collaboration with other healthcare professionals

QUESTION 3

3. In the following problem, explain briefly the feeling expressed by the client and the
actions for the Personal Support Worker to take

Situation 1

Mrs. Gregg continually uses her knife to eat with and is generally unable to choose the
correct utensil and unable to cut her meat. She has difficulty getting food to her
mouth. She resists help. One day she threw her plate across the room.

ANSWER

Feeling Expressed by the Client:

 • Frustration: This is likely the primary emotion. Mrs. Gregg's difficulty with eating is likely
frustrating for her. She may feel embarrassed, helpless, and angry at her inability to
perform this basic task independently.
• Anger: Throwing the plate demonstrates a clear expression of anger. This could be
directed towards herself for her limitations, towards you for offering assistance, or
towards the situation in general.

Actions for the Personal Support Worker:

• Remain Calm and Patient: Avoid reacting to the plate-throwing incident with anger or
frustration yourself.
• Acknowledge her Frustration: "I understand that this is difficult for you. It can be
frustrating when you can't eat the way you used to."
• Offer Choices and Support:
o "Would you like me to cut your meat for you?"
o "Would you like me to help you choose the right utensil?"
o "Let's try using this fork instead, it might be easier."
• Adapt Feeding Techniques:
o Use smaller bites.
o Offer thicker liquids or pureed foods if appropriate.
o Use adaptive utensils (e.g., built-up handles, angled utensils).
• Maintain Dignity and Respect:
• Avoid rushing her or making her feel rushed.
• Allow her as much independence as possible.
• Use person-centered language and respect her choices.
• Communicate with the Care Team:
• Report the incident and discuss potential solutions with the occupational therapist,
speech-language pathologist, or dietitian.
• Explore the possibility of a feeding evaluation to assess her swallowing abilities.

SITUATION 2
Mrs. Gregg has expressed a desire to read, but she is unable to understand the text in
her old books. She asks you to help her practice words. She says that she has trouble
passing the time and that she expects to return to work in several weeks.

ANSWER:

Feeling Expressed by the Client:

• Frustration: Difficulty reading likely frustrates Mrs. Gregg, impacting her self-esteem and
potentially hindering her recovery goals.
 • Boredom/Loneliness: "Trouble passing time" suggests she may feel isolated and
disconnected from her previous activities.
• Anxiety/Impatience: The expectation of returning to work may create anxiety and a
desire to regain her previous level of function quickly.

Actions for the Personal Support Worker:

• Acknowledge her Feelings: Validate her frustration and reassure her that improvement
takes time.
• Support her Reading Goals:
o Practice word recognition and reading aloud.
o Use simple, engaging materials (magazines, newspapers, large-print books).
o Explore reading technologies (e.g., text-to-speech software).
• Provide Cognitive Stimulation:
• Engage in conversation, puzzles, word games, and other mentally stimulating activities.
• Encourage Social Interaction:
• Facilitate visits from family and friends.
• Assist with joining social groups or attending community events.
• Set Realistic Expectations:
• Help Mrs. Gregg understand that recovery takes time and that setbacks are normal.
• Collaborate with the Care Team:
• Involve the speech-language pathologist in developing a personalized reading plan.

SITUATION 3
One day when you approach Mrs. Gregg, she is crying and says she doesn’t want to
get up. She says, “None of this should have happened to me. What did I do to deserve
this?”

ANSWER:

Feeling Expressed by the Client:

• Grief and Loss: Mrs. Gregg is experiencing grief and loss related to her stroke.
• Loss of independence: The stroke has significantly impacted her physical abilities and
independence.
• Loss of former self: She may be grieving the loss of her previous active lifestyle and
career.
• Loss of control: The stroke has taken away her control over her body and her life.
• Anger and Resentment:
• Anger towards her situation: "None of this should have happened to me."
• Resentment towards her body: Feeling betrayed and frustrated by her physical
limitations.
 • Self-Blame and Guilt: "What did I do to deserve this?" suggests she may be
experiencing feelings of self-blame or guilt, even if there is no justification for these
feelings.

Actions for the Personal Support Worker:

• Empathy and Validation:

o Acknowledge her feelings: "I can see that you're feeling very upset right now. It's
understandable to feel this way after a stroke."
o Offer comfort and support: "It's okay to feel this way. This has been a difficult
experience."
• Active Listening:
o Allow her to express her emotions without interruption.
o Listen attentively and reflect back her feelings: "You're feeling frustrated and
angry that you can't do things the way you used to."
• Avoid Dismissing Her Feelings:
o Do not minimize her pain or tell her to "look on the bright side."
• Encourage Expression:
o Suggest she talk to a therapist or counselor to explore her emotions further.
• Support her Coping Mechanisms:
o Encourage healthy coping strategies such as relaxation techniques, deep
breathing, or spending time in nature.
• Maintain a Positive and Hopeful Attitude:
o While acknowledging her challenges, focus on her strengths and celebrate her
successes.

SITUATION 4

Mrs. Gregg insists on getting up by herself and moving independently from her chair to
the bathroom. She uses a walker. Occasionally she falls. She is a private person and
does not want you to attend her in the bathroom.

ANSWER:

Feeling Expressed by the Client:

• Independence: Mrs. Gregg highly values her independence and autonomy.

• Privacy: She desires to maintain her dignity and personal space.
• Fear of Dependence: She may fear becoming completely reliant on others for basic
needs.

Actions for the Personal Support Worker:

• Respect her Wishes: Acknowledge and respect her desire for independence and
privacy.
 • Safety Measures:
o Assess the risk: Conduct a thorough fall risk assessment.
o Environmental modifications: Ensure the bathroom is safe (grab bars, non-slip
mats).
o Walker safety: Ensure the walker is properly adjusted and in good condition.
o Close supervision: Remain within earshot and be ready to assist if needed.
• Encourage Communication:
• Establish a clear signal system (e.g., call bell) for her to use if she needs assistance.
• Regularly check on her well-being.
• Support her Independence:
o Provide encouragement and positive reinforcement for her attempts at
independence.
o Offer assistance when she requests it.
• Collaborate with the Care Team:
o Discuss the situation with the occupational therapist and physical therapist.
• Explore the possibility of assistive devices (e.g., gait belt) that can provide support
while minimizing dependence.

QUESTION 4

4. Using all of the above information, describe how the following factors might affect Mrs.
Gregg’s relearning of speech and mobility. Use case study information to help answer
questions

ANSWER:

Age

o Challenges: Older adults may recover more slowly from a stroke compared to
younger people. Their brains may also have a harder time rewiring themselves
after a stroke. Other health problems that come with age can also make
recovery more difficult.
• Personality
o Motivation Matters: People who are motivated to recover and have a positive
attitude tend to do better.
o Coping Skills: How someone deals with stress and setbacks can affect their
recovery.
o Social Support: Having family and friends who help and support them is very
important.
• Environment
o Home Safety: A safe and accessible home is crucial.
o Community Help: Access to doctors, therapists, and community programs can
make a big difference.
 o Supportive Surroundings: Having a supportive environment at home and in the
community is important for recovery.

QUESTION 5

5. Describe five (5) ways in which the PSW can promote Mrs. Gregg’s self-esteem and
motivation during her daily routines.

ANSWER:

Highlight Small Wins: Acknowledging small achievements builds confidence and reinforces a
sense of accomplishment.

• Encourage Independence with Choices: Giving her choices fosters a sense of control
and autonomy, boosting self-esteem.
• Set Realistic, Achievable Goals: Gradual progress towards achievable goals builds
confidence and motivation.
• Positive Reinforcement with Specific Praise: Specific praise provides concrete evidence
of progress and reinforces positive behavior.
• Social Connection and Meaningful Engagement: Social interaction and meaningful
activities provide a sense of purpose and belonging, which are essential for maintaining
self-esteem.

QUESTION 6

6. Define Restorative Care and what role it would play in helping with Mrs. Greg’s
rehabilitation. How could the PSW assist with this process?

ANSWER:

Restorative Care focuses on helping individuals regain their previous level of function and
independence after a significant health event, such as a stroke. It emphasizes active
participation.

Role of Restorative Care in Mrs. Gregg's Rehabilitation:

• Restorative care would play a crucial role in helping Mrs. Gregg regain her
independence and improve her quality of life after her stroke.
• Regaining Mobility: Physical therapy would focus on improving her balance, strength,
and coordination, allowing her to walk with greater ease and independence.
• Regaining Speech: Speech therapy would help her improve her communication skills,
such as speaking more clearly and understanding others better.
 • Regaining Independence in Daily Living: Occupational therapy would help her regain
skills in areas such as dressing, grooming, and preparing meals.

How the PSW can Assist:

• Encouraging participation: Encouraging Mrs. Gregg to actively participate in her

rehabilitation exercises and therapy sessions.
• Practicing skills: Practicing the skills learned in therapy during daily routines, such as
transferring from bed to chair, using assistive devices, and communicating effectively.
• Maintaining a safe environment: Ensuring a safe and supportive environment at home to
facilitate recovery.
• Providing emotional support: Offering encouragement and emotional support to Mrs.
Gregg throughout her recovery journey.
• Collaborating with the healthcare team: Communicating with therapists and other
healthcare professionals to ensure a coordinated approach to care.